Recent Trends in Spine Surgery
Minimally Invasive Surgery (MIS) and Motion Preservation
Spine surgery is a constantly evolving field where the confluence of new technology and research continues to expand the available treatment options. Yet, even with the most advanced technology, there is no substitute for an open and honest physician/patient relationship. There are very few conditions of the spine that should not be treated conservatively at first, no matter which advanced surgical techniques are available. However, when non-operative measures fail, surgery may be necessary to reduce pain and restore function safely and effectively. Spine surgeons at Doylestown Health perform a wide variety of procedures including decompression of nerves via discectomy or laminectomy; or stabilization through fusion.
Advancements in Care
Over the last ten years, minimally invasive surgery (MIS) has been performed with increasing frequency, leading to fewer complications and faster recovery. Minimally invasive surgery is defined not just by the length of the skin incision, but by the relative reduction of soft tissue trauma. MIS has led to less blood loss during surgery, less post-operative pain, shorter hospital stays, and more rapid recovery times. While spinal fusion has traditionally been a successful way to treat certain conditions of the spine, newer techniques offer hope of retaining motion in the spine. A primary advantage of MIS spine surgery is the limited muscle dissection needed to access the spine. Often, it is the healing of the muscles and complications associated with it that dictates how long and how well a patient recovers. The newest generation of artificial disc replacements and techniques to insert mobile implants will hopefully lead to less fusion-related complications, and more active lifestyles.
Disorders and Treatments
Conditions Treated with MIS Spine Surgery and Dynamic Stabilization
Minimally Invasive Techniques and Dynamic Stabilization
- Circumferential Spine Fusion (Transforaminal Lumbar Interbody Fusion)
- eXtreme Lateral Interbody Fusion
- Axialif for Degenerative L4-S1 Disc Disease
- MIS Discectomy
- MIS Fracture Stabilization
- Kyphoplasty for Osteoporotic Compression Fractures
- Dynamic Stabilization
- Interspinous Implants for Stenosis
Another advancement utilized by spine surgeons at Doylestown Health is special instrumentation that allows outstanding visualization through tube-like retractors. The surgeon is able to separate the muscles with a series of tissue dilators instead of using a cauterizing knife to burn the tissue. The superior lighting associated with the retractor provides improved visualization and safety. Through these retractors, procedures such as laminectomies, discectomies, interbody fusions and placement of spinal instrumentation can easily be performed with minimal soft tissue dissection and maximum effectiveness.
Before MIS, a spine surgeon had to make a ten-inch incision for posterior fusion surgery; now the surgeon can use access sites about 1-2 inches in length. Once, a surgeon would have to incise the patient's entire side to access the spine; now the surgery can be performed effectively through two one-inch incisions that approach the front of the spine.
Another key advancement in MIS spine surgery is the use of real time radiography in order to safely place spinal implants with crucial precision. Techniques such as kyphoplasty for osteoporotic compression fractures, Axialif and eXLIF for lumbar fusions, and percutaneous spinal fixation can now be done safely with radiographic guidance. Together, the combination of technological advances, improved understanding of anatomy, and surgeon training has opened an exciting age where patient outcomes are improved, and patients more quickly regain their quality of life.
Scarring with Open Approach
Scarring with 3 level eXLIE